Healthcare Provider Details

I. General information

NPI: 1275971947
Provider Name (Legal Business Name): ROBERT CHANG DO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8265 W SUNSET BLVD STE 207
WEST HOLLYWOOD CA
90046-2470
US

IV. Provider business mailing address

8265 W SUNSET BLVD STE 207
WEST HOLLYWOOD CA
90046-2470
US

V. Phone/Fax

Practice location:
  • Phone: 323-375-0950
  • Fax: 323-315-5240
Mailing address:
  • Phone: 323-375-0950
  • Fax: 323-315-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A6808
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19448
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT P. CHANG
Title or Position: DOCTOR, LEAD PHYSICIAN
Credential: D.O.
Phone: 626-354-6789